目的:本研究旨在分享超声引导下甲氨蝶呤微创介入治疗异位间质妊娠(HIP)的经验,具有良好的妊娠结局,并回顾治疗方法,妊娠结局,以及对HIP患者未来生育能力的影响。
方法:本文描述了病史,临床表现,治疗史,以及一名31岁女性HIP的临床预后,并回顾了PubMed数据库中发布的1992年至2021年的HIP案例。
结果:患者在辅助生殖技术后8周经阴道超声(TVUS)诊断为HIP。通过超声引导的甲氨蝶呤注射使间质孕囊失活。宫内妊娠在妊娠38周时成功分娩。回顾了1992年至2021年在PubMed上发表的24项研究中的25例HIP病例。结合我们的情况,共有26例。根据这些研究,84.6%(22/26)的病例采用体外受精-胚胎移植,57.7%(15/26)患有输卵管疾病,23.1%(6/26)有异位妊娠史;53.8%(14/26)的患者出现腹痛,19.2%(5/26)的患者出现阴道出血.所有病例均经TVUS确诊。总的来说,76.9%(20/26)的宫内妊娠预后良好(手术与超声介入治疗1:1)。所有胎儿出生时没有异常。
结论:HIP的诊断和治疗仍然具有挑战性。诊断主要依靠TVUS。介入超声治疗和手术同样安全有效。合并异位妊娠的早期治疗与宫内妊娠的高生存率相关。
OBJECTIVE: This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients.
METHODS: The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database.
RESULTS: The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our
case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities.
CONCLUSIONS: The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.